What is Pontine Stroke: Causes, Symptoms, Treatment, Recovery, Survival Rate, Prognosis

Pontine stroke is a type of stroke that happens when the blood flow in the brain stem is disrupted. The stroke is caused by decrease blood supply to brain stem. The blood flow is restricted to brain stem because of either rupture of blood vessels causing bleeding (hemorrhagic stroke) or obstruction of blood flow because of blood clot within the artery resulting in obstruction of blood supply (ischemic stroke). The brain stem is responsible for breathing, heart function, digestion and alertness. Pontine stroke is very dangerous.

Symptoms of Pontine Stroke

The symptoms of pontine stroke may include difficulty in breathing, difficulty in speaking, difficulty with swallowing and chewing, complete or partial loss of hearing, paralysis, weakness of the limbs, loss of sensation or numbness and blurred vision. Dizziness and vertigo are two of the most common pontine stroke symptoms. These two symptoms are however not necessarily accompanied by a weak feeling in one side of the body.

Tests to Diagnose Pontine Stroke

There are many tests which can be conducted to diagnose pontine stroke. A pontine stroke is a life threatening condition and a medical emergency. Diagnosis of the condition can be sometimes difficult because the symptoms are more complex compared to clinical manifestation of other types of strokes. It is therefore very important to diagnose a pontine stroke as soon as possible in order to prevent development of life threatening condition. The patient’s nervous system response should be assessed along with the heart function and the blood oxygen levels. A computerized tomography (CT) scan is done to check the possible bleeding or clotting of blood within the brain tissue. Magnetic resonance imaging (MRI) studies of the brain and neck are performed to evaluate the condition of the brain and the neck. Doppler ultrasound studies are performed to evaluate bleeding from blood vessel as well as condition of blood flow to the brain. Electrocardiogram can also be done in order to assess the heart function. Other diagnostic testing includes blood tests, liver function tests and blood test to evaluate kidney function.

Treatment for Pontine Stroke

Treatment for pontine stroke can be more challenging due to the loss of basic life functions. If the cause of the pontine stroke is blood clot (ischemic stroke) then the first step in treatment may involve dissolving the clot and then restoring the blood flow. Tissue plasminogen activators are some of the drugs used to dissolve the clot. In few cases surgical treatment like embolectomy may be necessary to remove the clot. Patient may be kept on heparin or warfarin for few weeks to prevent repeat blood clotting.

Hemorrhagic stroke is caused by bleeding within brain. Treatment involves surgical removal of blood clot and possible placement of stent within the blood vessels to stop the bleeding. The stent placement is performed by neurosurgeon or radiologist.

The brain stem in the human body helps in regulating the blood pressure, heartbeat and your breath. The brain stem also regulates your eye movement, swallowing, speech and hearing. A pontine stroke is a life threatening condition as it endangers the vital bodily functions. There are two types of pontine strokes including ischemic pontine stroke and hemorrhagic pontine stroke.

Causes of Pontine Stroke

Causes of Pontine Stroke

Health conditions like diabetes, atrial fibrillation, elevated blood pressure and cardiovascular disease are the causes of pontine stroke. People with tendencies to form blood clots are more likely to experience pontine stroke. Smoking, alcohol use and consumption of a high percentage of processed food can also bring about pontine stroke.

If the cause of the stroke is blood clots (ischemic stroke) resulting in reduced blood flow to midbrain then long term blood thinning medication are prescribed to prevent formation of future blood clots. The medications like heparin, warfarin and newer synthetic medications like eliquis, pradaxa and xarelto are prescribed for several weeks. The blood clotting time is monitor to control the dosage of these medications. Medicine can also be given for high blood pressure.

The hemorrhagic pontine stroke in the brain is caused by ruptured and burst blood vessels, which supplies the blood to midbrain. The first line of treatment in this case involves stopping the bleeding first. Medicine can be given to control the blood pressure and medicines are also prescribed, which in the long run mitigate the effects of the bleeding in the brain stem. In case of an aneurysm then surgery is needed to stop the bleeding where the coil or the clip is then placed in order to stop the bleeding.

Recovery Period/Healing Time for Pontine Stroke

The recovery period or healing time for pontine stroke depends on the extent of soft tissue or midbrain injuries. The early it is diagnosed the quicker the patient will recover. Recovery period or healing time for pontine stroke also depends on the extend of residual tissue damage and therapeutic effects of medication. The long term recovery and prevention of recurrence depends on change of life style, discontinue smoking, control of blood pressure, treatment of irregular heart beats and maintaining proper diet. The pontine stroke patient will recover quicker if tissue damage is reversible and not extensive. The recurrence is prevented when patient follows doctor’s advised.

Survival Rate for Pontine Stroke

The survival rate for pontine stroke patient is higher if the stroke is ischemic. Life expectancy of people with Locked-in syndrome is about 10 years or more. It is therefore important for the patient to continue with medication and therapy for the entire life. Physical therapy under the supervision of the physician is needed in order to regain the motor skills by the patient. Occupational therapy is required to help the pontine stroke patient with the daily tasks. Speech therapy can also be done to improve the pontine stroke patient to regain speech and regain control over swallowing. Survivors of pontine stroke are often left with severe disabilities. Counseling may also be needed in order to help the patient adjust to their new life.

Prevention of Pontine Stroke

It is better to prevent a disease than to treat it. The best way to prevent the pontine stroke is to avoid the risk factors. Women should avoid long-term hormone replacement therapy to prevent formation of blood clots. Women above 35 years should also avoid smoking if taking hormone therapy. Avoid smoking and sedentary lifestyle as it increases the risk of getting pontine stroke. Avoid alcohol and other drugs such as heroin, cocaine and many more as it increases the risk of pontine stroke.

Complications of Pontine Stroke

The complications of the pontine stroke are impaired breathing and loss of consciousness. Coma and Locked-in syndrome are serious complication of pontine stroke. Locked-in syndrome is a condition whereby the entire body except for the eye muscles become paralyzed. The patient retains the ability to communicate and think only through the movement of the eye. This may include blinking. Patients with this syndrome need a gastric tube, catheter and tracheotomy to help them with the normal function of the body. The use of the eye movements helps to establish communication with the patient. This may include blinking. Approximately 1 percent of stroke patients suffer from psychosis in the form of hallucinations and delusions.

Prognosis/Outlook for Pontine Stroke

The outlook or prognosis majorly depends on the time it takes to diagnose the condition. The sooner the treatment is carried out, the better the prognosis for pontine stroke. If blood flow to the brain stem is restored within a few hours then permanent ischemic changes of the brain are prevented. The recovery is essentially better following earlier treatment, which often results the full recovery.

Lifestyle Changes for Pontine Stroke

Recovering patients following pontine stroke can maintained near normal life style if avoids smoking, stops drinking alcohol and do not consume heroin as well as cocaine. The patient should also seek advice and counseling from a psychologist. Patient should do regular exercises or yoga therapy to improve the blood circulation and muscle tone. The patient should go for regular health checkups and brain function follow up.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 22, 2018

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